Prediction: Split decison on change in Arkansas Medicaid rules

A Politico tipsheet says the expected visit of a Trump administration Medicaid official in Arkansas Monday will deliver a split decision for changes Gov. Asa Hutchinson has proposed in the Medicaid expansion program financed by Obamacare and offered through private insurers under Arkansas’s hybrid plan.

Hutchinson wants to 1) institute a work requirement for recipients of Medicaid coverage and 2) provide coverage only for those making 100 percent of the federal poverty level or less, not 138 percent. The latter proposal would throw 60,000 of the roughly 300,000 people covered off their health insurance. Hutchinson says they can turn to the federally subsidized market place, but most experts believe few will because of cost.

Here’s what Politico says:

ICYMI: APPROVAL OF ARKANSAS MEDICAID WAIVER IS IMMINENT — The Trump administration is poised to green-light a Medicaid waiver for Arkansas on Monday that would make it the third state to require some enrollees to work, multiple individuals with knowledge of the plan tell POLITICO’s Rachana Pradhan.

Gov. Asa Hutchinson discussed the waiver with HHS Secretary Alex Azar and other top federal health officials in Washington over the weekend. Hutchinson, a Republican who inherited Medicaid expansion from his Democratic predecessor, has steadily sought conservative changes to a program that remains controversial in the state.

— One big question: how HHS handles so-called “partial expansions” of Medicaid. Arkansas also wants to cap eligibility for Obamacare Medicaid expansion at the federal poverty line, a precedent that would let states tap billions in federal funds to cover low-income adults without fully embracing the law. Several sources are skeptical that HHS would approve such a move.

One lawsuit is already underway in Kentucky over a similar work requirement.

Why would the Trump administration want to resist an Arkansas change sure to reduce Medicaid expenses by reducing the number covered? Well, the change could be challenged in court, too. But a bigger risk for the Trump administration, trying to destroy Obamacare, is that it would encourage 20 states that have not joined the program to pitch in for fully funded federal coverage. Savings in Arkansas might encourage new costs elsewhere.

Asa can say he tried. Jan Morgan and the far right of the Republican Party will say any coverage is too much. The current budget session is still hanging on the Department of Human Services budget, with its billions in Medicaid expenses. Hutchinson needs 27 votes in a Senate that currently has only 32 filled seats, meaning six votes can stop the bill. Can a mixed announcement Monday put the bill over the top?

We don’t yet have confirmation that Seema Verma, the federal Medicaid and Medicare administrator who once worked as a private consultant in Arkansas on related issues, will be here Monday. Seeking it from the Department of Human Services.